Provider Demographics
NPI:1215270806
Name:PHILLIPS, LESLIE ERIN (SLP, MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:ERIN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SLP, MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 TAMMY DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5538
Mailing Address - Country:US
Mailing Address - Phone:317-757-6240
Mailing Address - Fax:
Practice Address - Street 1:7425 TAMMY DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5538
Practice Address - Country:US
Practice Address - Phone:317-757-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004258A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist